Category Archives: Smoking Cessation

Do you work more than 39 hours a week? Your job could be killing you

Long hours, stress and physical inactivity are bad for our wellbeing – yet we’re working harder than ever. Isn’t it time we fought back?

Health at work illo 1


Illustration: Leon Edler

When a new group of interns recently arrived at Barclays in New York, they discovered a memo in their inboxes. It was from their supervisor at the bank, and headed: “Welcome to the jungle.” The message continued: “I recommend bringing a pillow to the office. It makes sleeping under your desk a lot more comfortable … The internship really is a nine-week commitment at the desk … An intern asked our staffer for a weekend off for a family reunion – he was told he could go. He was also asked to hand in his BlackBerry and pack up his desk.”

Although the (unauthorised) memo was meant as a joke, no one laughed when it was leaked to the media. Memories were still fresh of Moritz Erhardt, the 21-year-old London intern who died after working 72 hours in a row at Bank of America. It looked as if Barclays was also taking the “work ethic” to morbid extremes.

Following 30 years of neoliberal deregulation, the nine-to-five feels like a relic of a bygone era. Jobs are endlessly stressed and increasingly precarious. Overwork has become the norm in many companies – something expected and even admired. Everything we do outside the office – no matter how rewarding – is quietly denigrated. Relaxation, hobbies, raising children or reading a book are dismissed as laziness. That’s how powerful the mythology of work is.

Technology was supposed to liberate us from much of the daily slog, but has often made things worse: in 2002, fewer than 10% of employees checked their work email outside of office hours. Today, with the help of tablets and smartphones, it is 50%, often before we get out of bed.

Health at work illo 2


Illustration: Leon Edler

Some observers have suggested that workers today are never “turned off”. Like our mobile phones, we only go on standby at the end of the day, as we crawl into bed exhausted. This unrelenting joylessness is especially evident where holidays are concerned. In the US, one of the richest economies in the world, employees are lucky to get two weeks off a year.

You might almost think this frenetic activity was directly linked to our biological preservation and that we would all starve without it. As if writing stupid emails all day in a cramped office was akin to hunting-and-gathering of a previous age … Thankfully, a sea change is taking place. The costs of overwork can no longer be ignored. Long-term stress, anxiety and prolonged inactivity have been exposed as potential killers.

Researchers at Columbia University Medical Center recently used activity trackers to monitor 8,000 workers over the age of 45. The findings were striking. The average period of inactivity during each waking day was 12.3 hours. Employees who were sedentary for more than 13 hours a day were twice as likely to die prematurely as those who were inactive for 11.5 hours. The authors concluded that sitting in an office for long periods has a similar effect to smoking and ought to come with a health warning.

When researchers at University College London looked at 85,000 workers, mainly middle-aged men and women, they found a correlation between overwork and cardiovascular problems, especially an irregular heart beat or atrial fibrillation, which increases the chances of a stroke five-fold.

Labour unions are increasingly raising concerns about excessive work, too, especially its impact on relationships and physical and mental health. Take the case of the IG Metall union in Germany. Last week, 15,000 workers (who manufacture car parts for firms such as Porsche) called a strike, demanding a 28-hour work week with unchanged pay and conditions. It’s not about indolence, they say, but self-protection: they don’t want to die before their time. Science is on their side: research from the Australian National University recently found that working anything over 39 hours a week is a risk to wellbeing.

Is there a healthy and acceptable level of work? According to US researcher Alex Soojung-Kim Pang, most modern employees are productive for about four hours a day: the rest is padding and huge amounts of worry. Pang argues that the workday could easily be scaled back without undermining standards of living or prosperity.

Health at work illo 3


Illustration: Leon Edler

Other studies back up this observation. The Swedish government, for example, funded an experiment where retirement home nurses worked six-hour days and still received an eight-hour salary. The result? Less sick leave, less stress, and a jump in productivity.

All this is encouraging as far as it goes. But almost all of these studies focus on the problem from a numerical point of view – the amount of time spent working each day, year-in and year-out. We need to go further and begin to look at the conditions of paid employment. If a job is wretched and overly stressful, even a few hours of it can be an existential nightmare. Someone who relishes working on their car at the weekend, for example, might find the same thing intolerable in a large factory, even for a short period. All the freedom, creativity and craft are sucked out of the activity. It becomes an externally imposed chore rather than a moment of release.

Why is this important?

Because there is a danger that merely reducing working hours will not change much, when it comes to health, if jobs are intrinsically disenfranchising. In order to make jobs more conducive to our mental and physiological welfare, much less work is definitely essential. So too are jobs of a better kind, where hierarchies are less authoritarian and tasks are more varied and meaningful.

Capitalism doesn’t have a great track record for creating jobs such as these, unfortunately. More than a third of British workers think their jobs are meaningless, according to a survey by YouGov. And if morale is that low, it doesn’t matter how many gym vouchers, mindfulness programmes and baskets of organic fruit employers throw at them. Even the most committed employee will feel that something is fundamentally missing. A life.

Peter Fleming’s new book, The Death of Homo Economicus: Work, Debt and the Myth of Endless Accumulation, is published by Pluto Press (£14.99rrp). To order a copy for £12.74 with free UK p&p, go to guardianbookshop.com

How rhythms become a vital part of us | A neuroscientist explains

This column has run weekly for more than two years but, from a biological perspective, that is a bizarre rhythm. Cells and systems in the brain and body have built-in mechanisms to enforce a 24-hour sleep-wake cycle. And light-sensitive cells in the eye and elsewhere keep that synched to the earth’s rotation.

Animals and plants regulate their activities on an annual cycle, becoming frisky in spring and hibernating over the winter. Again, intrinsic mechanisms tend towards an annual cycle and sensors of various kinds nudge it to keep track of the earth’s rotation around the sun.

The physiology of women shows a monthly periodicity in almost all aspects, although it’s not known whether that has more than a coincidental relation to the orbiting of the moon.

But it is culture, particularly religious culture, that has lighted upon the seven-day cycle as an organising structure for our lives. Once something is in the external world, however, it starts to invade our biology, particularly our neurobiology. That’s why it’s so hard to wake up on Sunday morning even if you were silly enough to have set your alarm clock. In the end, science is part of culture.

Dr Daniel Glaser is director of Science Gallery at King’s College London

Surgeons don’t have to sign their names… in us | Barbara Ellen

Surgeon Simon Bramhall, who burned his initials on to the livers of two transplant patients while working at the Queen Elizabeth hospital, in Birmingham, has been fined £10,000 and given a 12-month community order.

Bramhall (now working for the NHS in Herefordshire) was fortunate not to have been struck off. It’s disturbing enough to think of your body being opened up for surgery, but to have somebody leave their mark there (“SB”) is grotesque; as the court found, it was “an abuse of power, and a betrayal of trust”. Bramhall’s defence argued that it was to lighten the mood in theatre. Really? In that case, put on some quiet background music – don’t sign a human organ, as if you’re some kind of rock star in scrubs being pestered for an autograph.

It seems that there was no lasting harm done – the marks wouldn’t have affected the performance of the liver and they would disappear in time. However, there’s always harm done; if nothing else, such incidents bolster the widespread public perception of surgeons being arrogant and superior.

Too many cases such as this and patient-surgeon trust would be in grave danger of breaking down.

One cigarette ‘may lead to habit for more than two-thirds of people’

More than two-thirds of people who try just one cigarette may go on to become regular smokers, new research suggests.

Researchers found that just over 60% of adults said they had tried a cigarette at some point in their lives, with almost 69% of those noting that they had, at least for a period, gone on to smoke cigarettes daily.

“[This shows] prevention, providing [fewer] opportunities or reasons for young people to try a cigarette, is a good idea,” said Peter Hajek, co-author of the research, from Queen Mary University of London.

The research, published in the journal Nicotine and Tobacco Research, is based on data pooled from eight surveys conducted since the year 2000, including three each from the UK and USA, and a further two studies from Australia and New Zealand.

Together, the surveys included more than 216,000 respondents, with between 50% and 82% saying that, after trying a cigarette, they had gone on to smoke on a daily basis – at least temporarily. Further analysis showed that, taken together, an estimated 68.9% of individuals smoked daily for a period after trying a cigarette.

The team also looked at whether the results were likely to be skewed by smokers being less likely to respond in surveys than non-smokers, but no strong effect was found. However, the authors note that the study also has other limitations, including that the findings are based on respondents self-reporting information, meaning the resulting figures are only an estimate.

“It is possible that somebody who is a lifetime non-smoker did try a cigarette when they were a kid but it didn’t make any impression on them, and they forgot it or don’t see that it is important enough to report,” said Hajek. But, he added, “I think even if you assume there is a recall issue and other things, you are talking about more than a 50% [conversion rate from trying a cigarette to daily smoking].”

Decline in British smoking since 1974

Hajek added that declining rates of smoking among younger people suggested that measures such as restrictions on sales and a shift away from portraying it as glamorous were having a positive effect. But, he noted, the influence of e-cigarettes should also be explored, since the decline in smoking rates in England has accelerated since the devices came onto the market.

Linda Bauld, professor of health policy at the University of Stirling, said the study highlighted the importance of preventing smoking in the first place.

“Tobacco use starts in childhood for two-thirds of smokers in the UK, and this study suggests that even trying a cigarette becomes regular use in most cases,” she said.

“Fortunately, in the UK, youth smoking rates continue to decline – but we shouldn’t be complacent,” she added, noting that according to recent figures every year approximately 200,000 children in the UK try cigarettes for the first time. According to recent reports, there were almost one billion smokers worldwide in 2015, with numbers expected to rise – despite a drop in prevalence – as the global population grows.

Global smoking prevalence

Bauld also agreed that the role of e-cigarettes merited further study, pointing out that while it had been assumed that experimentation with e-cigarettes would also lead to regular use, that does not appear to be the case. “

While rates of e-cigarette experimentation amongst young people have risen in recent years, rates of regular use in teenagers who have never smoked remain at well below 1%, she said. “We need to be clear about this distinction and keep our focus on doing everything we can to prevent smoking, which we know is deadly, rather than demonising vaping, which all the evidence suggests is a hugely less harmful behaviour.”

Mental health support in schools: ‘Families don’t have to spend years on waiting lists’

When Grace Hartill was 11, she began to show the first signs of anxiety. Within a few years, the Barnsley schoolgirl had become withdrawn and had stopped wanting to see her friends.

“It was awful,” she says. “I didn’t want to leave my bedroom because I felt like if I did, something would happen to me or somebody I loved. Home was where I felt safest, so I just isolated myself. I barely went to school.”

As her mental health worsened, she was referred to child and adolescent mental health services (Camhs) but was on the waiting list for two years. When she finally did get treatment, it didn’t help. She adds: “Camhs and the other services I tried just didn’t help. I felt like the therapists didn’t want to be there.”

It wasn’t until a groundbreaking service, MindSpace, launched in her school that Grace began to experience some relief. Funded by Barnsley clinical commissioning group (CCG) through its Future in Mind fund, the initiative works by embedding mental health practitioners in secondary schools so children don’t have to be taken out of school to access treatment. The scheme, originally piloted last academic year by 10 schools and officially launched in October 2017, aims to tackle poor mental health while bypassing traditional services, which are seeing rising demand coupled with insufficient capacity.

Consisting of three primary health practitioners, a parent counsellor, a family support worker and an emotional health support worker, the MindSpace team offers one-to-one sessions and groups for specific issues such as bereavement. It is led by Michelle Sault, head of extended services at the Wellspring Academy Trust, who came up with the idea after running a pupil referral unit, and seeing children who she believed didn’t belong there.

“I think school is where a young person should be,” Sault says. “There are a lot of discrepancies in Camhs, and in schools that don’t have funding to provide as much pastoral support as is needed these days. It’s an injustice in a sense that young people aren’t supported earlier before things escalate.”

Before the launch of MindSpace, Grace’s mother, Lisa Robinson, was at her “wit’s end”; her son was struggling with anxiety and behavioural issues, and she also has mental health problems. She remembers: “None of us were in a good place. I thought we should give it a go and it will either work or it won’t. Thankfully it did. Grace was soon able to identify when she was having anxiety attacks and to understand that she wasn’t going to die.”

Within a few months, there was a marked improvement in the household. Both children were going to school without problems and Robinson, who was one of 63 parents who also received counselling, felt better than she had in years. “I think it’s amazing to have it in schools so that families don’t have to spend years on waiting lists and the whole family can be helped,” she says.

Grace agrees: “It made all three of us happier. It’s like we were searching for something that wasn’t there and then it came along. It really worked wonders. Compared to other services I tried, I felt like MindSpace really wanted to be there and they wanted to listen to me. They understood what I was going through and made me realise I wasn’t the only one going through it.”

Funding for the £1.3m programme, which is delivered in all Barnsley secondary schools, is guaranteed until at least 2020. In its first year, more than 200 young people have been supported and more than 100 teachers trained by Sheffield-based mental health charity Chilypep. The training is being rolled out to all staff in all the schools – and one of the key aims is to create an environment where everyone can be open about mental health and wellbeing.

Patrick Otway, head of commissioning for Barnsley CCG, says that while no formal evaluation has been published yet, numerous positive case studies have been gathered – and a full impact assessment is on the cards. “In 2013, we had gathered evidence that there was very little support for young people in Barnsley for lower level emotional needs,” he says. “At the time, there was no funding to develop the service – so when the Future in Mind report and funding became available, the CCG already knew what was needed.”

Statistics show that one in 10 children has depression, anxiety or another diagnosable mental health problem – so the MindSpace team hope to see the model rolled out nationally. Brigid Reid, chief nurse for the CCG, says it’s this combining of health and education that makes the scheme successful. “Having [Sault’s] insights into how schools work and what students and parents need, think and feel – and to marry that with the expertise of the practitioners employed, that’s what makes it unique,” she says.

Mental health practitioner Angela Yildiz agrees. “Education and health do work well together,” she says. “Initially there were some difficulties given this has never been done. But the teachers really work with me, not against me.”

For Kate Davies, headteacher at one of the schools, Darton college, the best thing about the scheme is it means teachers can concentrate on what they do best. “The concept of having trained mental health practitioners as part of the school – and ours really is part of the team – is so simple yet so obvious,” she says.

For Robinson’s family, the difference has been almost unbelievable, especially in Grace. “One day Grace came home from school and just said casually that she was going to her friend’s house. I could not believe what she was saying. That was the turnaround for Grace. She is now doing performing arts at college and is learning to drive. It’s the best decision I made as a mum, and as an individual.”

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You don’t have to be poor to be hooked on drugs or alcohol but it helps

Dry January ought to be the season to talk about drunks. According to what passes for the public health debate, unfortunately, most of society thinks there’s little to say.

If you drink yourself to death, while taking care along the way to abuse your family, friends and unlucky strangers who cross your path, that’s your fault. You believed Ernest Hemingway when he said “a man does not exist until he is drunk”. No one has the right to be surprised that the drink has finished you – as it finished Hemingway – least of all your own pickled self. Stay too long at the bar, and you must expect to hear last orders called.

We have telethons and sponsored tests of endurance for every conceivable ailment. The charitable raise money to combat poverty in developing nations, cancer and heart disease. But I have yet to hear of a marathon run to save alcoholics from marathon binges or a public appeal on behalf of drying-out clinics. There’s no money in public health. Or votes either.

What applies to drink, applies to drug addiction, sexually transmitted diseases and obesity. In each instance, arguments you hear are filled with a mixture of denial and blame. The discourse is inherently conservative because it affirms that public intervention is pointless. People who cannot get through a week without a drink or a Saturday night without getting plastered are by any reasonable standard addicts. I speak from experience when I say that no heavy drinker agrees with this diagnosis. A line separates wild men on park benches from you and me having a good time. Britain’s tipsy culture won’t say where the line is for fear too many would find themselves on the wrong side. Never doubt that when you have crossed it, you alone will bear the blame.


I have yet to hear of a marathon run to save alcoholics from marathon binges or a public appeal on behalf of drying-out clinics

In this climate of punitive neglect, addiction and obesity are dismissed as diseases of choice, which to use that most class-bound of Tory insults, the “nanny state” cannot cure. It’s true that breaking free from heroin, alcohol or sugar requires an effort of individual will. It is equally true that it is easier to summon the strength to quit when others are on hand to help. These truths ought to be self-evident. But they are not evident in Britain. Virtually everyone who is running to fat has at one time or another denied the results of body-mass index tests that report they are obese. The index would find that Olympic sprinters are overweight, we say, in our defence. So it would. Yet how many of those who say it have the muscles of Usain Bolt?

To be fair, dieting is discussed to excess – unlike alcoholism and drug addiction. But the conversation is dominated by fad diets that always disappoint. When even the BBC, promotes obscurantist delusions about fasting, the favoured weight-loss strategy of medieval mystics, there is an urgent need for the state to foster public health.

The state is failing because the Conservatives have got away with a great, shining lie. Journalists who think themselves speakers of truth to power rarely notice the fabrication. Opposition politicians who bellow about the depth of their hatred of “the Tories” allow ministers to escape without criticism. The lie is that the government has ring-fenced health spending from cuts. The argument about health spending has thus been an argument about the government’s failure to allow the NHS to keep up with the costs of an ageing population and advances in medical technology.

Few spotted that, with a magician’s sleight of hand, the government removed public health from health spending in 2013, and – hey presto! – public health was no longer defined as health. This playing with names, these accounting tricks, have allowed ministers to pretend they are not cutting health spending at the very moment they cut it. The King’s Fund described how the con went down. There were good reasons for giving local authorities control of public health. Councils regulated pubs and fast-food restaurants. Of course they should be responsible for alcoholism and obesity. If Britain is ever to catch up with the rest of Europe and encourage people to walk, run and cycle, the bulk of the work would fall to local authorities. Once again it made sense for them to take the lead on fitness.

For a few years all went well. Then in June 2015, the Treasury clawed back £200m from the public health grant. Local authorities took on responsibility for childhood obesity. The money they received for the extra work hid the scale of the cuts. But not for long. The last spending review announced a reduced income in real terms of £600m a year until 2020-21. Services to help men, women and children stop smoking and to control the spread of sexually transmitted diseases including Aids are already a mess. Meanwhile, I’ve interviewed drug and alcohol workers with scores of clients on their books they cannot begin to help. Their one relief is the sight of rich junkies because they know that all they want is methadone and will get what counselling they need privately.

Speaking of the rich, one cannot overlook the class element in the government’s trickery. You don’t have to be poor to be drink or drug dependent. But it helps. Michael Marmot’s great work on inequality in health shows how it is determined by the wider inequalities of society that deny access to education and decent housing. This is another truth which ought to be self-evident, particularly in Britain where the poor and working class are twice as likely to be obese than their better-born peers.

Obesity costs Britain £20bn in NHS spending and lost working days, and that is before you count the human price of lives shortened by diabetes and heart disease. But as I started with booze let me finish with it. Public health is not separate from the national health. You can’t hide it in a corner and strangle it in the dark. Alcohol contributes to 60 illnesses from mouth cancer to depression. A man who abuses a woman is likely to be driven by drink. A driver who runs you down is likely to be drunk. Alcohol consumption accounts for more than one million hospital admissions a year and over half of all violent crimes.

That the government should lie when it says it has protected the health budget is bad enough. That it can get away with lying is astonishing. Alcoholics Anonymous describes alcohol as “cunning, baffling and powerful”. So it can seem. But it has nothing on the Conservative party.

You don’t have to be poor to be hooked on drugs or alcohol but it helps

Dry January ought to be the season to talk about drunks. According to what passes for the public health debate, unfortunately, most of society thinks there’s little to say.

If you drink yourself to death, while taking care along the way to abuse your family, friends and unlucky strangers who cross your path, that’s your fault. You believed Ernest Hemingway when he said “a man does not exist until he is drunk”. No one has the right to be surprised that the drink has finished you – as it finished Hemingway – least of all your own pickled self. Stay too long at the bar, and you must expect to hear last orders called.

We have telethons and sponsored tests of endurance for every conceivable ailment. The charitable raise money to combat poverty in developing nations, cancer and heart disease. But I have yet to hear of a marathon run to save alcoholics from marathon binges or a public appeal on behalf of drying-out clinics. There’s no money in public health. Or votes either.

What applies to drink, applies to drug addiction, sexually transmitted diseases and obesity. In each instance, arguments you hear are filled with a mixture of denial and blame. The discourse is inherently conservative because it affirms that public intervention is pointless. People who cannot get through a week without a drink or a Saturday night without getting plastered are by any reasonable standard addicts. I speak from experience when I say that no heavy drinker agrees with this diagnosis. A line separates wild men on park benches from you and me having a good time. Britain’s tipsy culture won’t say where the line is for fear too many would find themselves on the wrong side. Never doubt that when you have crossed it, you alone will bear the blame.


I have yet to hear of a marathon run to save alcoholics from marathon binges or a public appeal on behalf of drying-out clinics

In this climate of punitive neglect, addiction and obesity are dismissed as diseases of choice, which to use that most class-bound of Tory insults, the “nanny state” cannot cure. It’s true that breaking free from heroin, alcohol or sugar requires an effort of individual will. It is equally true that it is easier to summon the strength to quit when others are on hand to help. These truths ought to be self-evident. But they are not evident in Britain. Virtually everyone who is running to fat has at one time or another denied the results of body-mass index tests that report they are obese. The index would find that Olympic sprinters are overweight, we say, in our defence. So it would. Yet how many of those who say it have the muscles of Usain Bolt?

To be fair, dieting is discussed to excess – unlike alcoholism and drug addiction. But the conversation is dominated by fad diets that always disappoint. When even the BBC, promotes obscurantist delusions about fasting, the favoured weight-loss strategy of medieval mystics, there is an urgent need for the state to foster public health.

The state is failing because the Conservatives have got away with a great, shining lie. Journalists who think themselves speakers of truth to power rarely notice the fabrication. Opposition politicians who bellow about the depth of their hatred of “the Tories” allow ministers to escape without criticism. The lie is that the government has ring-fenced health spending from cuts. The argument about health spending has thus been an argument about the government’s failure to allow the NHS to keep up with the costs of an ageing population and advances in medical technology.

Few spotted that, with a magician’s sleight of hand, the government removed public health from health spending in 2013, and – hey presto! – public health was no longer defined as health. This playing with names, these accounting tricks, have allowed ministers to pretend they are not cutting health spending at the very moment they cut it. The King’s Fund described how the con went down. There were good reasons for giving local authorities control of public health. Councils regulated pubs and fast-food restaurants. Of course they should be responsible for alcoholism and obesity. If Britain is ever to catch up with the rest of Europe and encourage people to walk, run and cycle, the bulk of the work would fall to local authorities. Once again it made sense for them to take the lead on fitness.

For a few years all went well. Then in June 2015, the Treasury clawed back £200m from the public health grant. Local authorities took on responsibility for childhood obesity. The money they received for the extra work hid the scale of the cuts. But not for long. The last spending review announced a reduced income in real terms of £600m a year until 2020-21. Services to help men, women and children stop smoking and to control the spread of sexually transmitted diseases including Aids are already a mess. Meanwhile, I’ve interviewed drug and alcohol workers with scores of clients on their books they cannot begin to help. Their one relief is the sight of rich junkies because they know that all they want is methadone and will get what counselling they need privately.

Speaking of the rich, one cannot overlook the class element in the government’s trickery. You don’t have to be poor to be drink or drug dependent. But it helps. Michael Marmot’s great work on inequality in health shows how it is determined by the wider inequalities of society that deny access to education and decent housing. This is another truth which ought to be self-evident, particularly in Britain where the poor and working class are twice as likely to be obese than their better-born peers.

Obesity costs Britain £20bn in NHS spending and lost working days, and that is before you count the human price of lives shortened by diabetes and heart disease. But as I started with booze let me finish with it. Public health is not separate from the national health. You can’t hide it in a corner and strangle it in the dark. Alcohol contributes to 60 illnesses from mouth cancer to depression. A man who abuses a woman is likely to be driven by drink. A driver who runs you down is likely to be drunk. Alcohol consumption accounts for more than one million hospital admissions a year and over half of all violent crimes.

That the government should lie when it says it has protected the health budget is bad enough. That it can get away with lying is astonishing. Alcoholics Anonymous describes alcohol as “cunning, baffling and powerful”. So it can seem. But it has nothing on the Conservative party.

My charity sees the toll of job losses on mental health – we struggle to meet demand

As chief executive of a small mental health charity in one of the poorest areas of north east England, I don’t sleep well. We deliver frontline recovery services in Redcar & Cleveland and in 2011 our funding was cut by 61% in one fell swoop. We used to get £350,000 from the local authority; now we manage on £135,000.

Meanwhile, mass unemployment and financial pressure have taken their toll on people’s mental health and we’ve seen demand more than double. The steelworks used to be the lifeblood of our community and its closure in 2015 has been catastrophic.

Across the country, suicide is the biggest killer of men under the age of 50 and rates of depression and anxiety in young people are spiralling. We see the human face of those statistics every day, and although I am an eternal optimist, most days are tinged with upset and anger.

I regularly meet staff who work in search and rescue. We offer them resilience training and mental health support through our Blue Light Programme. We know that staff and volunteers working within the emergency services are at increased risk of suicide due to stress.

One instance that particularly stays in my thoughts is when a young volunteer from a local search and rescue team was involved in the harrowing experience of retrieving a body from the foot of Huntcliff, a beautiful and majestic landmark along our coastline. They had just had their first experience of the trauma of suicide and remained in my thoughts all day. It’s volunteers like that who potentially need our services.


Too many people need us, and our resources are limited. Very limited.

Later that day I received a call from my 19-year-old son. The body retrieved from Huntcliff was someone he knew. The sad irony is not lost on me: three young people of a similar age. One is dead, one may not sleep due to what they have witnessed, and the other is touched by sudden bereavement. What words do I choose that can possibly make this better? I am at a loss.

I do what I do today because of my own lived experience. In 2006, out of the blue, I suffered a life-threatening depressive episode. It lasted six months from onset to recovery. During that time struggling to understand my mental illness, I made repeated attempts to take my life. Back then I had no idea that services like Redcar & Cleveland Mind existed. I survived through the support of my wonderful children, a great GP and some very loyal friends. But I know some people aren’t so lucky.

I will do everything within my power to make sure our service continues to be there for anyone who needs it. But therein lies the problem. Too many people need us, and our resources are limited. Very limited.

Our Road to Recovery service is funded to support people with “mild to moderate” mental health problems. We are asked to categorise people depending on how unwell they may be, or how much support they may need. If they are too ill, we’re not funded to help them. But of course we do. We will treat them as real people and help them to realise that their lives matter.

We make a small income on the Well4Work training we offer employers to help them support their staff’s mental health – but this is all reinvested into the work we do. We increasingly rely on donations, often from those bereaved by suicide.

Mental health doesn’t have the appeal of other charitable causes, unless it touches people directly. We will continue to fight for those you may have loved and lost. And in the meantime I remain hopeful that in this new year we will see Huntcliff in its majestic glory rather than as a place where hopelessness claims more lives. As for me, I suspect 2018 will bring many more sleepless nights.

In the UK the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international suicide helplines can be found at www.befrienders.org.

This series aims to give a voice to the staff behind the public services that are hit by mounting cuts and rising demand, and so often denigrated by the press, politicians and public. If you would like to write an article for the series, contact kirstie.brewer@theguardian.com

Talk to us on Twitter via @Guardianpublic and sign up for your free Guardian Public Leaders newsletter with news and analysis sent direct to you every month

Woman nearly blinded by Christmas card glitter

A woman was nearly blinded by a Christmas card when a piece of glitter worked its way into her eyeball.

The 49-year-old attended the ophthalmology department of Singleton hospital in Swansea complaining of a painful, reddened eye, loss of vision and swollen eyelid.

Doctors spotted a lesion on the patient’s cornea and initially suspected it to be caused by a herpes simplex infection, according to a case study published in the British Medical Journal (BMJ). But when the lesion was examined under a powerful microscope, a shiny surface was spotted inside.

The patient remembered getting glitter in her eye when it rubbed off a Christmas card. The glitter had formed into a clump, causing a lesion that mimicked the symptoms of a herpes infection, the report said.

The report advised doctors to always ask about the cause of a possible trauma to the eye, even if the symptoms seemed to clearly indicate a common infection.

“The lesion may have been easily misdiagnosed as a herpetic simplex infection by non-specialists for which treatment would have been topical antiviral ointment instead of removal and antibiotics,” the report said.

Indian doctors protest against plan to let ‘quacks’ practise medicine

Indian doctors have accused the government of seeking to “sanction quackery” by proposing to allow homeopaths and others trained in alternative remedies to practise conventional medicine after taking a bridging course.

Doctors at private hospitals held protests on Tuesday while their counterparts in public facilities wore black armbands in opposition to the proposal, part of a sweeping overhaul of medical governance.

Aimed at addressing a severe shortage of doctors, particularly in rural areas, the bill would allow people who dispense Siddha, Ayurvedic and other traditional Indian remedies to practise medicine after taking a course, the length of which is yet to be decided.

A similar law already in place in Madhya Pradesh state licenses traditional healers to dispense and prescribe 72 medicines after taking classes for three months.

The Indian Medical Association has criticised the plan, saying it will “lead to an army of half-baked doctors in the country”, according to the association’s president, KK Aggarwal.

“The government is giving sanction to quackery,” he said. “If those doctors make mistakes and people pay with their lives, who is going to be held accountable?”

SS Uttre, the president of the Maharashtra state medical association, said the proposal would dilute medical education and provide a “back-way entry into medicine”. He added: “We are going to oppose it tooth and nail.”

Although India has more than 400 medical schools producing tens of thousands of high-quality graduates annually, the country has about 12 doctors, nurses or midwives per 10,000 people – less than half the World Health Organization benchmark.

Thousands of graduates each year prefer to take their skills to the US or UK, or are drawn to well-paid jobs in the burgeoning private health industries of big cities such as Delhi or Mumbai.

As a result, research three years ago found more than 2,000 primary health centres around the country lacked even one doctor to treat patients, with shortages of surgeons and specialists even more acute.

Many Indians turn instead to traditional remedies such as Ayurveda – treatments prepared according to recipes from ancient Hindu texts – or to “quacks” who present themselves as doctors but lack any medical qualifications. About 57% of purported Indian doctors are thought to fall into the latter category.

Similarly, according to a 2014 study, traditional healers already carry out clinical care in as many as one in three primary health centres in rural or tribal areas.

To address the shortage, state and federal governments have experimented with licensing non-specialist doctors to carry out caesarean sections or administer anaesthetics.

Village social workers and “quack” doctors have also received formal training in basic medicine, while under a health ministry proposal, traditional healers will soon be permitted to deliver babies, carry out non-invasive abortions and treat certain noncommunicable diseases.

Ayurveda, yoga and other traditional practices have been championed by the current government, led by the Hindu nationalist Bharatiya Janata party, which in 2014 established a ministry to promote alternative remedies. At least 65 Ayurvedic “hospitals” have been established in the past three years, with more planned.

Rules for rigorous testing of Ayurvedic products have also been relaxed or waived, despite the concerns of medical scientists who say there is insufficient evidence to recommend their use in clinical settings.

Another state, Gujarat, has sought to alleviate the doctor shortage by equipping some children with stethoscopes and allowing them to administer Ayurvedic treatments for “minor diseases” to their classmates.

The government bill under scrutiny also proposes to scrap the doctor-run Medical Council of India and replace it with a new organisation overseen by health officials and free of the taint of corruption allegations, which have dogged the council.

Doctors’ groups say the proposed changes are undemocratic and shift power from medical professionals to regulators who are without experience in the field.

Medical groups said they would return to work after the government agreed to send the bill to a standing committee in parliament for further examination. Uttre said doctors would fight the proposal for bridging courses in any form and appeal to the supreme court if necessary.